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',i,_ 7.1r. CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00158
:if ,- 4 ;4' DATE ISSUED: 4/24/2007
TIGARD: 1 3125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 103 DA -04100
SITE ADDRESS: 13365 SW 107TH AVE ZONING: R -3.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: LASATER
Project Description: Replace galv. water supply lines with wirsbo. Not connecting to fixtures at this time. Replacing
elec. water heater with gas.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
KARL LASATER
136 NW 107TH AVE Description Date Amount
PORTLAND, OR 97229 [PLUMB] Permit Fee 4/24/2007 $72.50
[TAX] 8% State Surcha 4/24/2007 $5.80
Phone : 503 -314 -0652 Total $78.30
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 -0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: i , z 't-- Permittee Signature: 1',j-
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbin:? Permit Applicat CEI tlED FOR OFFICE USE ONLY
City of Tigard APR 21# 2001 � 7 07 i fj Permit N. L 6 1 2a, 7, Ill
a 13125 SW HaII Blvd., Tigard, OR 97 23 Plan Revie
• Phone: 503.639.4171 Fax: 503.54111 °r TIGARp Date/By. Other Permit No.:
Inspection Line: 503.639.4175
BUILDING DIV ISION Page T 1 G\ h D gar g Notified/Method: h o d: , Supplemental Information
Internet: www.ti d or. ov
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklLsi.
Description 1 Qty. 1 Ea. 1 Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
❑ 1- and 2-family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: /33 SAV 10 7 Z 6 t .e Catch basin or area drain 1 16.60
City / State/ZIP: 7/6,4' a 9 -2 a_)- 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: 9 Footing drain (no. linear ft.: , ) Page 2
Cross street/directions to job site: y94(/ /:47e. / @ 107 Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _ ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.:
Water service (no. linear ft.: ) ) Page 2 7g, 30
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK
Back flow preventer Page 2
i ?t44 C 6 ' /,j, N/E!Z .‘"%-P"Lk L/ --s Backwater valve 16.60
tell vy ,fIj /v /We Clothes washer 16.60
io
�� 11&f hid I 'tit, q 1 � • Dishwasher 16.60
W (�'O ` RP C ER G TY OWNER
/ I ❑ TENANT Drinking fountain 16.60
Ejectors sump 16.60
Name: Mal_ L. . f/9 _ Expansion tank 16.60
Address: 73 45 SL+/ / 6 7 V 1 1 16- Fixture/sewer cap 16.60
City /State/ZIP: 7 7 ,i)7ZQ Pie_ 1? 9).- 3 Floor drain/floor sink/hub 16.60
P h o n e : ( . . . ) /y 06, 5'L Fax: ( ) Garbage disposal 16.60
• ❑ APPLICANT ❑ CONTACT PERSON
Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60 _
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone:( ) Fax::( )
Sink/basin/lavatory 16.60
Tub /shower/shower pan 16.60
E-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: a t-1 Water heater / 16.60
Address: Other:
City / State/ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) ,,,�
Authorized signature: 1 TOTAL PERMIT FEE'1//Zj
Print name:, ', L. Ls9fPI It Date: I// _ %X 7 This permit application expires if a permit is not obtained within
//� 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\ Bui lding\Permin\P1.M- PamitApp.doc 06/26/06 440-4616T(10/O2/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. - Fee (ea) Total Square Footage: Permit Fee:
Footing drain - I 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Storm &Rain Drain - 1st 100' 55.00
51.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to 525,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Back flow Prevention Device each additional $100.00 or fraction thereof to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Future Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink -2" that meet the qualifications above.
-3"
-4"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal -Commercial
- industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
-Bradley fees assessed for the sewer increase must be paid before the
- Commercial p
Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal •
Other Fixtures:
is Bui lding\Permits \PLM- PermitApp.doc 09/22/06
r 4 ,
; C Y OF TIGARD
l i
� 7 I 2 PL U MBING PERMIT
•
i, COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00158
TIGAR,DI 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/24/2007
PARCEL: 2 S 103 DA -04100
SITE ADDRESS: 13365 SW 107TH AVE ZONING: R -3.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: LASATER
Project Description: Replace galv. water supply lines with wirsbo. Not connecting to fixtures at this time. Replacing
elec. water heater with gas. 6/6/07, Adding 100 ft of water service from house to meter.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 200 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
KARL LASATER
136 NW 107TH AVE Description Date Amount
PORTLAND, OR 97229 [PLUMB] Permit Fee 4/24/2007 $72.50
[TAX] 8% State Surcha 4/24/2007 $5.80
[PLUMB] Permit Fee 6/6/2007 $55.00
Phone : 503-314-0652 [TAX] 8% State Surcha 6/6/2007 $4.40
Total $137.70
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
■ Issu =d By: A �% i � 4 - i Permittee Signature:
i %
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
CITY OF TIGARD fLIL1 ?An- )6
BUILDING DIVISION PERMIT #:
b ik 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5
Phone: (503) 639 -4171 Ili
Inspection Requests (24 Hrs.): (503) 639 -417
INSPECTION WORKSHEET FOR DATE: & /7,3/4 TIME: PAGE:
SITE ADDRESS: 1 1 I t CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
36 FLH Fw-v O
Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
� ` q / 7 3/ ( ) z /.4 Inspector: .it j Date: Phone #: 503 718-
Case Activity Listing 9/23/2008
CCEL%
Case # : PLM2007 -00158 9:34:32AM
Assigned Done Updated
Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes
PLM1010 Application received 4/24/2007 None RECD BB 4/24/2007
BB
PLM1020 Permit created 4/24/2007 None DONE BB 4/24/2007
BB
PLM 1030 Check for parcel tags 4/24/2007 None DONE BB 4/24/2007
BB
PLM 1280 Issue permit 4/24/2007 None DONE BB 4/24/2007
BB "..-NI
PLM1290 Reprint permit 6/6/2007 None DONE DEB 6/6/2007
BLD'
PLM1530 Permit expired by 4/14/2008 None DONE RB 4/14/2008 5
limitation RB SS
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Page 1 of 1 CaseActivity..rpt